Scottish Longitudinal Study
Development & Support Unit
The determinants of self-assessed health in Scottish adults
Gavin MacColl (Scottish Government)
Karen MacNee (Scottish Government)
Julie Ramsay (Scottish Government)
Approved on 17-11-2009
The Scottish Government target “to match average European ( EU15) population growth over the period from 2007 to 2017, supported by increased healthy life expectancy in Scotland over this period”, is linked with the National Indicator to “Increase healthy life expectancy at birth in the most deprived areas.” Healthy life expectancy captures differences in health status within the population (Wood et al., 2006). Life expectancy (LE) and healthy life expectancy (HLE) are both lower in Scotland than in the UK as a whole (Popham 2006, ScotPHO 2008). In addition HLE is increasing more slowly than LE and there is an increasing health gap in the Scottish population, particularly in deprived groups. Population estimates and deaths data are used to calculate LE and a third component, survey based self-assessed general health (SAH), is used to calculate HLE (Burlison, ScotPHO, 2008).
Data records from the 2001 Census show that Scottish people report higher levels of poor general health and limiting long term illness, when compared with England (Popham 2006). Self-assessed health correlates with limiting long-term illness (Manor et al., 2001) and people living in the 15% most deprived of areas in Scotland twice as likely to say their health is ‘not good’ compared with those living elsewhere (Scottish Household Survey, 2007/2008). Subjective health assessments are also related to subsequent health outcomes (Mossey and Shapiro 1982). Therefore, SAH can be used to follow changes in health status, with SAH scores linked to conditions such as epilepsy, diabetes and cancer, as well as health behaviours including smoking and unhealthy diet (Manor et al., 2001; Power and Elliot 2005). SAH is also predictive of mortality and those rating their health as poor have a higher risk of premature mortality than those rating their health as good (Mossey and Shapiro 1982).
This study will use the SLS population samples from the 1991 census and 2001 census to establish the determinants of self assessed health and limiting long-term illness in the Scottish population. The study has 3 central hypotheses:
- Educational attainment, income and employment status all influence self-assessed health and limiting long-term illness scores.
- Self-assessed health scores in 2001 are strongly linked to subsequent morbidity and mortality outcomes.
- Poor self-assessed health and limiting long-term illness show an inequalities (deprivation) gradient and support existing data showing concentrations of morbidity and mortality in specific Scottish regions.
Manor O, Matthews S and Power C. Self-rated health and limiting longstanding illness: inter-relationships with morbidity in early adulthood. International Journal of Epidemiology 2001; 30: 600-607.
Mensah FK and Hobcraft J. Childhood deprivation, health and development: associations with adult health in the 1958 and 1970 British prospective birth cohort studies. Journal of Epidemiology and Community Health 2008; 62; 599-606.
Mossey JM and Shapiro M. Self-Rated Health: A predictor of mortality among the elderly. American Journal of Public Health 1982; 72: 800-808.
Popham F. Is there a "Scottish effect" for self reports of health? Individual level analysis of the 2001 UK census. BMC Public Health 2006; 6:191-202.
Power C and Elliot J. Cohort profile: 1958 British birth cohort (National child development study). International Journal of Epidemiology 2005; 35: 34-41. Scottish Public Health Observatory: Healthy Life Expectancy 2008.
Wood et al., Measuring inequalities in health: the case for healthy life expectancy. Journal of Epidemiology and Community Health 2006; 60:1089-1092.
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